During my site evaluation meeting, I presented a case involving an 82-year-old male with chronic dizziness and lightheadedness, particularly with positional changes and while ambulating outdoors. Initially, I thought the presentation was likely due to orthostatic hypotension given his age, lower blood pressure, and metoprolol use. However, discussing this case made me realize that dizziness in geriatric patients is often multifactorial and requires maintaining a broad differential diagnosis.

Dizziness in older adults is important because it can represent anything from a benign condition to a more serious neurologic or cardiovascular disorder. In addition, it increases the risk of falls, hospitalization, functional decline, and loss of independence. Evaluating these patients can also be challenging because symptoms are often vague and may be described as weakness, imbalance, or lightheadedness rather than true vertigo. One of the biggest lessons I learned from presenting this case was the importance of clarifying what patients mean when they describe feeling “dizzy.” I also learned to consider medication effects and psychosocial factors in addition to underlying medical conditions. While orthostatic hypotension appeared to be the leading diagnosis, anxiety in public settings and vitamin B12 deficiency also needed to be considered as contributing factors.

During my final site evaluation meeting, I presented a case involving an 83-year-old female with chronic constipation and multiple cardiovascular and neurologic comorbidities. Initially, I viewed the presentation as uncomplicated constipation related to aging. However, discussing this case made me realize that symptoms that initially appear straightforward in geriatric patients can have several contributing factors that need to be considered.

One of the biggest things I learned from presenting this case was the importance of evaluating medication use and understanding the impact of polypharmacy in older adults. I also learned that constipation itself is not necessarily a diagnosis, but rather a symptom that may be caused by an underlying condition. When a patient presents with constipation, it often requires a more detailed evaluation to avoid missing important or less common causes that may be clinically significant. While many cases can be related to aging, decreased gastrointestinal motility, or medication use, it is still important to consider and rule out more serious conditions such as bowel obstruction, fecal impaction, or malignancy.

Looking back at both of my site evaluation meetings, I noticed a common theme of learning how complex patient presentations can be in the geriatric population. Although both patients initially presented with complaints that seemed relatively straightforward, such as dizziness and constipation, I learned that symptoms in older adults are often multifactorial and require a broader clinical approach. Through these presentations, I developed a greater appreciation for considering factors such as medication effects, psychosocial components, comorbidities, and age-related physiologic changes when evaluating geriatric patients.